Foot & Ankle International - 2017 FAI Supplement - 28S

influence on outcomes. No differences were identified with
subset stratification by prosthesis type, fixed versus mobilebearing design or etiology.
Conclusion: In this TAR cohort with prospectively collected
outcomes data, radiographic sagittal plane ankle motion was
positively correlated with multiple PROMs. Disease-specific
and generic health-related quality of life PROMs demonstrated
improvement postoperatively in all domains. TAR is a viable
option for patients with end-stage ankle arthritis and increased
ROM is associated with improved patient-centric metrics.
Foot & Ankle International, 38(S1)
DOI: 10.1177/1071100717S00024
©The Author(s) 2017

Patient-Reported Outcomes
Demonstrate the Value Of NonOperative and Operative Orthopedic
Treatments and Predict the Odds Of
Improvement With Surgery
Andrew Haskell, MD, Todd S. Kim, MD
Category: Outcomes Measurement
Keywords: Patient Reported Outcomes PROMIS Computer
Adaptive Testing
Introduction/Purpose: The importance of patient
reported outcomes (PROs) has become increasingly recognized as an important tool to measure our clinical
value. The National Institute of Health (NIH) created the
Patient-Reported Outcomes Measurement Information
System (PROMIS), a series of validated item banks, to
help clinicians and researches measure key clinical
domains. The PROMIS computer adaptive tests (CAT)
may be administered with minimal resources or administrative burden.
This study describes the results of administering computer
adaptive tests (CAT) to every patient in a high volume
Orthopedic Surgery practice. We test the hypotheses that
both non-operative treatment and operative treatments
improve PRO scores. Furthermore, we test the hypothesis
that preoperative scores in these domains may be used to predict chances of improvement after surgery.
Methods: The PROMIS CAT was administered prospectively for all patients as part of standard clinic intake and

28S

recorded in the patient's electronic medical record (EMR)
at each clinic visit. The PROMIS item banks are normalized
to mean 50±10 for the US population. De-identified data
was retrospectively extracted from the EMR including
PROMIS scores, demographic information, as well as surgery specific information. As of this submission, 1688
PROMIS CATs from March 2015 to September 2016 have
been analyzed.
Data for initial and final clinic visits, as well as for the
final preoperative visit for patients who had surgery, are
compared using Wilcoxon Matched Pairs Test for paired
samples and Mann-Whitney U Test for unpaired samples.
Linear regression is used to assess the association of initial values to change in value after treatment. The effect
of stratified initial clinic domain value on odds of
improving with surgery is assessed using Analysis of
Variance.
Results: Non-surgical and surgical patients present with similar pain intensity (49.6±7.9 vs. 49.4±7.8). Surgical patients
do not improve prior to surgery, but both improve by their
final visit (45.7±7.5, 43.7±8.8, p<0.05).
Non-surgical and surgical patients present with similar pain
interference (60.0±8.4 vs. 60.3±8.9). Surgical patients do not
improve prior to surgery, but both improve by their final visit
(56.9±8.8, 54.3±9.4, p<0.05).
For surgical patients, change in pain intensity and pain interference correlate with initial values (R2 0.32 and 0.27,
p<0.05). The percentage whose pain intensity improves after
surgery when initial value is over one SD worse than mean is
96%, within one SD worse than mean is 81%, within one SD
better than mean is 56%, and over one SD better than mean is
40% (p<0.05).
Conclusion: Both non-operative and operative orthopedic
treatments improve patient reported pain intensity and pain
interference.
For patients that have surgery, patients that present with more
severe symptoms tend to improve more with surgery.
Furthermore, the odds of improving after surgery can be calculated based on preoperative PRO scores. This may allow
surgeons to counsel patients about the potential benefits of
surgery with personalized precision that is currently
unavailable.
Measuring PROs using PROMIS CATs demonstrates the
value of both non-operative and operative Orthopedic
Surgery care for our patients. Preoperative PRO scores may
predict the odds of successful surgical intervention.

Foot & Ankle International 38(1S)

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